Department of Cardiology, Ghent University Hospital, Gent, Belgium.
Cardiology Department, Erasmus Medical Center, Rotterdam, Netherlands.
Heart. 2021 Nov;107(21):1704-1709. doi: 10.1136/heartjnl-2020-318183. Epub 2021 Jan 19.
Cardiovascular disease is the leading cause of death during pregnancy with thoracic aortic dissection being one of the main causes. Thoracic aortic disease is commonly related to hereditary disorders and congenital heart malformations such as bicuspid aortic valve (BAV). Pregnancy is considered a high risk period in women with underlying aortopathy.
The ESC EORP Registry Of Pregnancy And Cardiac disease (ROPAC) is a prospective global registry that enrolled 5739 women with pre-existing cardiac disease. With this analysis, we aim to study the maternal and fetal outcome of pregnancy in women with thoracic aortic disease.
Thoracic aortic disease was reported in 189 women (3.3%). Half of them were patients with Marfan syndrome (MFS), 26% had a BAV, 8% Turner syndrome, 2% vascular Ehlers-Danlos syndrome and 11% had no underlying genetic defect or associated congenital heart defect. Aortic dilatation was reported in 58% of patients and 6% had a history of aortic dissection. Four patients, of whom three were patients with MFS, had an acute aortic dissection (three type A and one type B aortic dissection) without maternal or fetal mortality. No complications occurred in women with a history of aortic dissection. There was no significant difference in median fetal birth weight if treated with a beta-blocker or not (2960 g (2358-3390 g) vs 3270 g (2750-3570 g), p value 0.25).
This ancillary analysis provides the largest prospective data review on pregnancy risk for patients with thoracic aortic disease. Overall pregnancy outcomes in women with thoracic aortic disease followed according to current guidelines are good.
心血管疾病是妊娠期间的主要死因，其中胸主动脉夹层是主要原因之一。胸主动脉疾病通常与遗传性疾病和先天性心脏畸形有关，如二叶式主动脉瓣（BAV）。对于有潜在主动脉病变的女性，妊娠被认为是高风险期。
ESC EORP 妊娠与心脏疾病注册研究（ROPAC）是一项前瞻性全球注册研究，共纳入了 5739 名患有先心病的女性。通过这项分析，我们旨在研究患有胸主动脉疾病的女性妊娠的母婴结局。
189 名女性（3.3%）报告患有胸主动脉疾病。其中一半为马凡综合征（MFS）患者，26%为 BAV 患者，8%为特纳综合征患者，2%为血管型埃勒斯-当洛斯综合征患者，11%无潜在遗传缺陷或相关先天性心脏缺陷。58%的患者存在主动脉扩张，6%有主动脉夹层病史。四名患者（其中三名 MFS 患者）发生急性主动脉夹层（三例 A 型主动脉夹层和一例 B 型主动脉夹层），但无母婴死亡。有主动脉夹层病史的女性未发生并发症。接受β受体阻滞剂治疗与未接受治疗的胎儿出生体重中位数无显著差异（2960g（2358-3390g）与 3270g（2750-3570g），p 值 0.25）。
这项辅助分析提供了关于胸主动脉疾病患者妊娠风险的最大前瞻性数据回顾。根据目前的指南，患有胸主动脉疾病的女性的总体妊娠结局良好。
